|Year : 1970 | Volume
| Issue : 2 | Page : 75-77
Entodon therapy in central serous retinopathy
G Radhakrishna Murthy
Anantapur, (A.P.), India
G Radhakrishna Murthy
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Murthy G R. Entodon therapy in central serous retinopathy. Indian J Ophthalmol 1970;18:75-7
Central Serous retinopathy is an ophthalmic entity characterised clinically by sudden fall of vision in one or both the eyes, perception of a central grey or black spot and micropsia and metamorphopsia leading to the tell-tale evidence of macular stippling after passage of time, with a marked tendency for recurrence; ophthalmoscopically by oedema or swelling of macular area with a circular, oval or irregular light reflex, indistinct or absent foveal reflex, rarely small haemorrhages near macular vessels; perimetrically by relative central scotoma for form and colour, and rarely by an absolute scotoma. That the aetiology and pathology are still far from satisfactory is evident from the variety of names suggested, viz., Central angiospastic retinopathy by Gifford and Marquardt, pre-retinal oedema by Guist, Chorioretinitis centralis Serosa by Kitahara, retinitis centralis angioneurotica of Horniker, etc. Because of this uncertainty in aetiology, there are several lines of treatment followed. In all such conditions, Iodides have been used by ophthalmologists since over a century. The mode of action of iodides is believed to be to aid and hasten the absorption of exudates and haemorrhages.
Iodides have been used both in the inorganic and organic forms. Inorganic iodine salts have certain disadvantages, viz., onset of gastric disturbances, fodism in sensitive patients, reactions due to disturbances of the colloidal equilibrium, severe pain of the injections when given parenterally and delayed therapeutic action when given orally. On the other hand, organic iodine preparations have the drawback that the firm linkage of iodine and carbon in their structure allows only slow release of iodine in the tissues which may be inadequate for therapeutic purposes. To obviate this difficulty, the organic iodine compound - Entodon - has been prepared in which the iodine is not attached to carbon but to nitrogen, which leads to a uniform and rapid liberation of iodine in the tissues. Entodon is chemically. 20% solution of hexamethyl-diamino-iso-propanoldi-iodide containing 0.118 g of iodine per ml and is administered either intravenously or intramuscularly. The demonstration of iodine in saliva within two minutes and in urine within 5 to 15 minutes after intravenous injection of Entodon is a clear evidence for the rapidity of its action.
| Materials and Methods|| |
The present clinical study is reported because of the remarkable clinical improvement - both functionally and structurally - even in delayed cases of central serous retinopathy. Six cases of central serous retinopathy in various stages of the disease, were treated with Entodon and the results studied. All of them gave the typical history of sudden diminution of vision of one eye and ophthalmoscopic examination revealed beyond doubt the characteristic fundus picture with the typical glistening ring surrounding the macular area. The detailed laboratory investigations did not reveal anything specific but for positive V.D.R.L. in one case and raised E.S.R. in two cases. Dental sepsis was found and eradicated in one case. All these cases were started on Streptopenicillin, BI and B12 parenterally and Betamethasone and B Complex orally. After this preliminary treatment, there was found to be only partial improvement of vision. Then, the patients were given a course of 10 injections of Entodon 1 ampoule intravenously or deep intragluteally on alternate days. There was very rapid clinical improvement even during the period of treatment and normal or near-normal vision was restored in all the cases within a period of 4 to 8 weeks.
| Case Reports|| |
CASE 1: Mrs. S. D., a housewife, aged 28, reported on 26.5.67 and complained of sudden loss of vision of right eye on 19.4.67. She noticed it suddenly while reading, when she found that she could see nothing with the right eye when she closed her left eye. She immediately consulted a local doctor who advised her Vitamin B 12 therapy and check-up after a month. As she found no improvement, she consulted the author. External examination of either eye did not reveal any abnormality. Her vision was: R. E. V. Counting fingers at 1/4 metre. L. E. V: 6/5. Fundus examination clinched the diagnosis of central serous retinopathy right eye. Dental, E. N. T. and gynaecological examinations did not reveal any septic foci. V. D. R. L. was weak positive and E. S. R. 10 mm after 1 hour. The results of all other investigations were normal. She was given
(i) a course of 5 injections of Streptopenicillin followed by P. A. M. 2 cc. I. M. daily for 10 days
(ii) Intramuscular B 1 (100 mgm), B 12 (1000 mg.) and B 6 injections on alternate days.
(iii) Oral Betamethasone in tapering doses;
(iv) Nicotinic acid x 250 mgm. tablets: one a day.
(v) B Complex Forte with Vitamin C capsules: one a day.
On 24.6.67 her vision in right eye improved to 6/18. She was advised to continue (iv) and (v) and have (vi) Entodon 1 amp. deep intragluteally on alternate days for 10 injections. On 1.8.67 her R. E. V. was 6/9, when she was asked to continue iv and v only. When she came for check-up on 30.8.1967, her R. E. V. was 6/5 and fundus revealed fine macular stippling only.
CASE 2: Mr. S. G. R., 22, male, noticed diminution of vision of both eyes suddenly on 25.11.67 when he tried to read newspaper in the morning. He had headache for two days preceding the fall of vision but he had no other complaint before. He came for consultation on 27.11.67, when his visual acuity was R. E. V. 6/12, LEV: C. F. ½ M and both fundi showed macular oedema and stippling surrounded by a glistening ring, though the changes were more pronounced in the left eye. None of the investigations gave positive results, nor was there any evidence of any focal sepsis. He was given (i) Streptopenicillin (ii) B 1 B 12 B 6 and (iii) Oral Betamethasone. On 2.12.67, his vision was R. E. V.: 6/12; L. E. V. 6/36. He was then put on (iv) Nicotinic acid tablets (v) B Complex .Forte tablets and (vi) Entodon 1 amp. I. V. on alternate days.
Even after the fifth injection of Entodon, the vision improved to 6/6 in both the eyes and after completion of the course his vision was 6/5 in both the eyes. The fundi showed complete disappearance of oedema leaving behind only fine stippling of macula.
CASE 3: Mr. A. R., male 43, reported on 4.12.67 with the complaint of fall of vision of sudden onset a month ago. He had divergent squint of right eye since childhood which had a vision of 2 metres only. His L. E. V. was 6/60 and funduscopy revealed central serous retinopathy left eye. He was advised to have (iv), (v) and (vi) above. He returned only once for check-up after a fortnight when his L. E. V. had improved to 6/9.
CASE 4: Mr. S. N., 33, male, appeared on 4.11.67 with a vision of 6/12 both eyes with the typical fundus picture.
He was administered (iv), (v) and (vi). After a month, his vision improved to 6/9 in right eye and 6/6 in left eye.
CASE 5: Mr. P. R., 35, male, complained on 5.4.68 of dimness of vision of right eye of 3 days duration. His vision was: R. E. V. 6/24 and L. E. V. 6/5. He was given (i), (ii), (iii) and (vi). His R. E. V. was 6/5 on 30.4.68.
CASE 6: Mr. I. M., 30, male, reported on 11.11.68 complaining of sudden fall of vision of right eye of 2 days duration. His R. E. V. was C. F. 5M and L. E. V. 6/6. He was given (i), (ii ) and (iii) but his R. E. V. was 6/60 only on 26.11.68. Then, he was started on (iv), (v) and (vi). His R. E. V. improved to 6/12 on 14.12.68 and 6/6 on 6.1.69.
| Discussion|| |
In all the six cases studied, Entodon therapy resulted in remarkable clinical improvement whether it was given after, with or without antibiotics. Treatment with antibiotics, B 1 , B 12 combination, nicotinic acid and B Complex either alone or in combination has not produced such good results. As improvement in visual acuity as well as fundus picture has been obtained in all the cases, Entodon therapy is considered to be of definite value in the treatment of central serous retinopathy.
| Acknowledgements|| |
The author is grateful to M/s. Bayer (India) Ltd., for the samples of Entodon supplied from time to time for the clinical trials.